Hot Seat/Graduated Responsibility

[levels x3]

Does your program have a "hot seat" rotation of any kind? How is it set up? Does it work? Or does it simply comlicate things and throw a wrench into the surg path workflow?

I've been thinking about the whole "graduated responsibility" thing lately as I'll be leaving residency and taking a job without a fellowship. In the 14 months I have left, I'm trying get myself as comfortable as possible with the idea that I'll actually have to sign something out soon (knowing that I'll still likely spend 20 minutes on that first tubular adenoma that has my name on the report).

---

Members don't see this ad.

 

[paleman]

Does your program have a "hot seat" rotation of any kind? How is it set up? Does it work? Or does it simply comlicate things and throw a wrench into the surg path workflow?

I've been thinking about the whole "graduated responsibility" thing lately as I'll be leaving residency and taking a job without a fellowship. In the 14 months I have left, I'm trying get myself as comfortable as possible with the idea that I'll actually have to sign something out soon (knowing that I'll still likely spend 20 minutes on that first tubular adenoma that has my name on the report).

naah hot seat or no hot seat there will be cases you want to show others and others you will not.. if you need to show a TA you're in trouble my friend

 

[mrp]

Geez, I showed a TA at conference today. Hmm.

 

[levels x3]

"hyperbole":
- noun: obvious and intentional exaggeration

Though as mrp suggests, I'm sure there will be TA's that I show colleagues someday and I wouldn't presume otherwise.

Has anyone done anything or is anyone planning to do anything differently during their final year to psych themselves up for the eventuality of taking complete responsibility for their cases? I do what I can by writing everything up as if I were signing it out, but what other suggestions do people have?

 

[pathdoc68]

if you need to show a TA you're in trouble my friend

I don't know - sometimes HGD or pseudoinvasion vs. invasion in polyps gets passed around. I never discourage anyone from showing anything. Big egos and misplaced overconfidence can get in the way of optimum patient care and safety.

 

[djmd]

Though as mrp suggests, I'm sure there will be TA's that I show colleagues someday and I wouldn't presume otherwise.

Might I take this opportunity to mention my hypothetical fictional business... Tubular Adenomas unlimited... we will happily take all Tubular Adenomas...

 

[levels x3]

Funny...I've always joked about opening Hyperplastic polyps and Seborrheic Keratoses Unlimited...

 

[mrp]

That's funny. Almost every day I'm on service, I fantasize about having a practice where all I see all day long are TA's. It would be boring, but at least I wouldn't be so terrified all the time.

 

[levels x3]

Come on now...the good life is in Seb K's...no high-grade dysplasia to worry about...no invasion...I don't care how inflamed or squamatized they are, I will take all SK's...

By the way, I have no pretentions of ever doing a dermpath fellowship, I just want all the general surgeons out there doing >5 mm margin excisions for SK's to know that I'm your man. I'll take BCC's too...and actinic keratoses...Bowen's...follicular tumors...nevi...seriously...I'm not doing a DP fellowship...just well trained as a resident...general surgeons take note...

 

[green mantis]

Has anyone done anything or is anyone planning to do anything differently during their final year to psych themselves up for the eventuality of taking complete responsibility for their cases?

Everyone at my residency applied for surgical pathology fellowships. I don't think anyone from my program, in the time I was there, has gone directly into practice.

I personally think it's a disturbing trend, but I wouldn't be able to get a job where I want to live otherwise.


----- Antony

 

[cytoborg]

Does your program have a "hot seat" rotation of any kind? How is it set up? Does it work? Or does it simply comlicate things and throw a wrench into the surg path workflow?

I've been thinking about the whole "graduated responsibility" thing lately as I'll be leaving residency and taking a job without a fellowship. In the 14 months I have left, I'm trying get myself as comfortable as possible with the idea that I'll actually have to sign something out soon (knowing that I'll still likely spend 20 minutes on that first tubular adenoma that has my name on the report).

We graduate responsibility by writing up our cases prior to signout. We generally encourage people to start writing up our cases halfway through the first year of AP (although some of us start much earlier) and then in 2nd year of AP we can start ordering our own stains, levels etc while previewing. It's a subtle thing but does get me one step closer to feeling like it's "my case." During the SPF which most of us do in our geographic region, there is a hotseat rotation where every slide (biopsy or big) processed at our institution goes through the hotseat (consults excluded - separate rotations for that). There are not signout priviledges per se.